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Q: We are using anti-bacterial catheters and have had good success in reducing urinary tract infections (UTIs). We are interested in knowing whether there are "best practice" guidelines for securing devices for Foley catheters. The ones we have tried use either tape or some other type of adhesive, or they don't allow the catheter to be switched from one leg to the other without being replaced. Our staff has not been satisfied with any of the many devices we've tried. Do you have any recommendations?

A: We are not aware of any best practice guidelines for catheter securement. Your question is very important because failure to secure the catheter can contribute to several adverse outcomes including infection, traction pain, migration of the catheter into the bladder neck, and tissue damage. (1,2) As you mentioned, there are inherent problems with some of the most commonly used methods. Tape may not adhere to a slick catheter surface and can damage fragile skin. (1) The restrictive nature of leg straps or any securement device that encircles the leg can increase risks in some patients for deep vein thrombosis and pulmonary embolism. (1) Other devices include combinations of adhesives and fasteners. One hinged device that anchors the catheter to an adhesive pad on the leg has received much attention for reducing the incidence of catheter migration and infections. (4-6) You indicated, however, that these devices also were unsatisfactory to your staff. This situation underscores the need to minimize the use of indwelling catheters whenever possible and to evaluate the needs of each patient separately. We welcome suggestions and comments from healthcare professionals who have developed guidelines for catheter securement within their facilities.